Trigger Point Injection

Trigger Points
Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibers and the formation of trigger points. Patients may have regional, persistent pain resulting in a decreased range of motion in the affected muscles. These include muscles used to maintain body posture, such as those in the neck, shoulders, and pelvic girdle.

Common Sites of Trigger Points

 Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and low back pain. Palpation of a hypersensitive bundle or nodule of muscle fiber of harder than normal consistency is the physical finding typically associated with a trigger point. Palpation of the trigger point will elicit pain directly over the affected area and/or cause radiation of pain toward a zone of reference and a local twitch response. Various modalities, such as the Spray and Stretch technique, ultrasonography, manipulative therapy and injection, are used to inactivate trigger points. Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms

 Predisposing and perpetuating factors in chronic overuse or stress injury on muscles must be eliminated, if possible.

 Nonpharmacologic treatment modalities include acupuncture, osteopathic manual medicine techniques, massage, acupressure, ultrasonography, application of heat or ice, diathermy, transcutaneous electrical nerve stimulation, ethyl chloride Spray and Stretch technique, dry needling, and trigger-point injections with local anesthetic, saline, or steroid. The long-term clinical efficacy of various therapies is not clear, because data that incorporate pre- and posttreatment assessments with control groups are not available

Contraindications to Trigger-Point Injection

Anticoagulation or bleeding disorders Aspirin ingestion within three days of injection The presence of local or systemic infection Allergy to anesthetic agents Acute muscle trauma Extreme fear of needles

Equipment Needed for Trigger-Point Injection

Rubber gloves Gauze pads Alcohol pads for cleansing skin 3- or 5-mL syringe Lidocaine (Xylocaine, 1 percent, without epinephrine) or procaine (Novocain, 1 percent) 22-, 25-, or 27-gauge needles of varying lengths, depending on the site to be injected Adhesive bandage

Complications of Trigger-Point Injections

Vasovagal syncope Skin infection Pneumothorax; avoid pneumothorax complications by never aiming a needle at an intercostal space. Needle breakage; avoid by never inserting the needle to its hub. Hematoma formation; avoid by applying direct pressure for at least two minutes after injection.